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Cognitive Function In Hypertensive Patients With Or Without Other Risk Factors Associated

 
Objective: To detect possible cognitive impairment in a population of hypertensive elderly patients (older than 65 years) in a geographic region. Estipulate the frequency of others risk factors besides hypertension and to detect the situation named as mild cognitive impairment.

Design and Methods: The data was extracted from a sample of hypertensive patients (n=270) diagnosed in a private clinic of neurologist and internal medicine doctor during last year(2003). The patients were submitted to a clinical history, physical and neurological examination, a neuropsychological battery testing, including memory, language, visual spatial cognitive function exams, laboratory evaluation, carotid ecography and neuro-image in those with abnormality in neuropsychological testing or neurological examination.

Results: Statiscal analysis was made with variation by categories. Basic information was used for all the co-varieties defined as follows: age, sex, education level, race and the presence or not to cardiopathy, diabetes, previous stroke (3 months), depression, familiar history (dementia or cardiovascular), dyslipidemia, hormonal replacement therapy, tabagism, alcohol, and psycho tropics use.

Data processing from neuropsychological test battery was evaluated inside three factors: Memory, cognitive and language. We used the following scales: Minimental, CDR, Hachinsky, Blessed, Wais, Clock test, Wword delayed recall and the Mood assessment scale for depression.-We identified 190 patients with cognitive impairment: they were classified in subtypes of MCI: MCI AD=16,MCI VASCULAR=82, MCI PD=7, MCI NORMAL AGE=12, MCI WITH DEPRESSION=2O, MCI OTHERS=8 patients. The patients with Alzheimer disease according with NIH-ADRDA criterio were in number of 23; 10 with Vascular dementia (NINDS-AIREN critério); 9 mixta (AD +VD); DFT=2; LBD=1. Isolated systolic hypertension was found in 1l patients with MCI AD (amnestic form) and 18 patients with Alzheimer disease. This relationship between high blood pressure (especially high systolic pressure) is reported in several population-based studies and suggests that systolic hypertension may be a risk factor for AD. The recognition of MCI as transition phases between healthy ageing and dementia serves as an important tool for investigation of treatments aimed at secondary prevention of dementia. The highly prevalent subtype of vascular cognitive impairment in this sample of hypertensive patients is significant as well; the societal cost for cognitive deterioration secondary to vascular disease is close to that of AD, and nearly 27% of patients with vascular MCI converts to dementia within 2 years as reported by the Canadian group. The incidence of depression was significative in the patients with MCI=45%; these patients with MCI and depression have been found to be a high risk group for subsequent dementia with conversion rates stimated in 61% over 3 years representing a harbinger of dementia. The incidence of cognitive impairment (englobing MCI or dementia) in hypertensive diabetics type I or II (n=45) was 82%=37 patients. The incidence in hypertensive patients with cardiopathy is very high too: 49 patients in a total number of 55 (89%). There was a very high incidence of cognitive impairment in cronic hypertensive patients with both pathologies (DM + Cardiac disease) in this sample = 93,7%; n=15/16. This date is according with other populational studies that shows a strong relationship between cognitive impairment in hypertensive patients after 65 years when associated to diabetes and cardiopathy. The results suggest that cholesterolemia is an important risk factor for the development of vascular cognitive impairment and also Alzheimer disease. Another significant association in this sample is between the findings of carotid disease especially carotid intima media thickness and cognitive impairment. Neuro-imaging is an important tool in dementia diagnosis, not oníy to exclude reversible causes of the dementia syndrome but is essencial in diagnosis of vascular cognitive impairment. In this series we use RMI or CT to identifie strokes and the presence of white matter changes that in many patients were severe enough to cause cognitive disfunction.

Conclusion: Relation between SAH treated or not and the occurrence of possible cognitive impairment in this sample of patients was made and association to others vascular disorders and its prevalence. The benefit from precocious diagnostic of these patients were established. The initial treatment and screening evolution, tryes to prevent potentially dementing pathologies in our population, with the high grade of dependence and morbity associated and immense costs for the society and health public system. Ab: SAH=Sistemic Arterial Hypertension; MCI= mild cognitive impairment; AD= Alzheimer disease; PD=Parkinson disease FTD=Fronto-temporal dementia; LBD=Lewi bodies dementia.

RESUMO DE TRABALHO APRESENTADO NO ENCONTRO INTERNACIONAL ALZHEIMER-PARKINSON EM 2005 EM SORRENTO ITÁLIA

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